Provider Demographics
NPI:1255588158
Name:BECKER, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12145 STATE HIGHWAY 14 N TRLR L2
Mailing Address - Street 2:L-2
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9504
Mailing Address - Country:US
Mailing Address - Phone:239-464-2817
Mailing Address - Fax:
Practice Address - Street 1:12145 STATE HIGHWAY 14 N TRLR L2
Practice Address - Street 2:L-2
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9504
Practice Address - Country:US
Practice Address - Phone:239-464-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist